The Facts

New Internationalist Issue 272

Health - the facts

Today's world is not a picture of health. Increases in longevity and improved child survival have been overshadowed by an ever-widening gap in health between rich and poor.

But there have been some gains. Eight out of ten children have been vaccinated against the major childhood killers. And between 1980 and 1993 infant mortality fell by 25% and overall life expectancy increased by more than four years.

GREAT EXPECTATIONS

Poverty, according to the World Health Organization, is the world's deadliest disease. The wealth-health gap for under-fives is remarkable - in some rich countries 6 out of every 1,000 children die before the age of five, whereas in 16 low-income countries the rate is over 200 per 1,000. In Niger it is 320 per 1,000.

Life expectancies are nearly twice as high in rich countries as they are in poor ones. In five of the poorest, life expectancy will decrease by the year 2000, while in some of the richest it will increase from around 76 to 79 years. The relationship between life expectancy and GNP is obvious, as the chart (left) shows.

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HEY BIG SPENDER

There are big differences in the percentages that governments spend on health - though the percentages translate very differently into actual money - for example, Costa Rica spends $132 per person on health but 32% of its budget while Canada spends $1,945, which is only 5.2% of its budget. Most regions in the Majority World can only afford to spend between 2% and 6% of their budgets on health, while industrialized countries spend nearly twice that amount - 13% on average.

A question of access

While more spending on health is a good thing, in most Southern countries three-quarters of healthcare goes to the cities, whereas the majority of the population lives in rural areas - and therefore has limited access to health services. Three-quarters of deaths in these countries could be prevented by primary health-care, but most of the budgets go on expensive cures.2

A significant proportion of the world's drugs are either used inappropriately or don't work.

An estimated $9 billion is wasted every year because of the irrational use of antibiotics.3

Two-thirds of all drugs used by children may have little or no value. $1 billion a year is wasted on useless antidiarrhoeal drugs and cough and cold remedies, mainly in the Majority World.4

German companies sold 65% of their irrational drugs in 1991/92 exclusively to the Majority World - these drugs could not be sold in Germany.5

Cheap effective remedies are often overlooked. Iodine-deficiency disorders cause 30,000 stillbirths each year and over 120,000 babies are born with severe disabilities. The solution - iodizing salt supplies - costs as little as $0.05 per person per year.

ALL IN THE MIND

Mental ill health is at the bottom of medical priorities, with severe conditions getting minimal care even in wealthy countries. Yet:

Some 500 million people suffer from neurotic, stress-related and psychosomatic disorders.

Some 200 million more suffer from mood disorders, such as depression, with 59 million people disabled.

Around 150 million people suffer from congenital mental conditions.

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KILLERS

The largest numbers of deaths are through communicable and, often, treatable diseases. Combined with deaths related to childbearing they account for 40% of global deaths: 99% of these occur in the Majority World.

Former 'diseases of prosperity' such as cancer and heart disease are now equally split between the 'developed' and 'developing' world. This is mainly due to the spread of pollution and fatty diets in the South. Smoking kills three million people a year and is the largest single preventable cause of death. There are many diseases which don't always kill but which worsen the quality of life for millions. Each year, diarrhoea affects 1.8 billion children under five, and sexually transmitted diseases affect 297 million new people.

WATER TREATMENT

The majority of the world's population lacks adequate sanitation, thus providing good conditions for infectious diseases to spread. The lack of safe drinking water leaves the channels open for waterborne scourges.

WORKING IT IN

Some 120 million occupational accidents with more than 200,000 deaths are estimated to occur every year.

Each year there are between 68 and 157 million new cases of work-related diseases.

More than 30% of workers in industrialized countries complain about stress and overload. The total economic loss amounts to 10-15% of GNP in these countries.6

IMMUNITY

World goals are to immunize at least 90% of the world's children and 90% of women of childbearing age by the year 2000. But the gains of the last two decades are now being eroded by apathetic policies. Immunization rates in Africa are only around 50%. Inner cities of many industrialized countries have immunization rates lower than those in 'developing' countries. Around 2.4 million deaths of children under five are still due to vaccine-preventable diseases. The efficacy of vaccines themselves is now under fire in the West.

All facts, unless otherwise noted, are taken from the World Health Organization's World Health Report 1995: Bridging the Gaps (WHO, Geneva).1State of the World's Children 1995 (UNICEF).2The Ethical Consumer: Special Report on the Pharmaceutical Industry, No 32, November 1994.3Superbug: Nature's Revenge G Cannon (Virgin Books, London 1995).4Scrip, No 1633, 12 July 1991.5An Alternative Report on Trade ICDA (Brussels, 1995).6In Point of Fact, WHO, No 84, April 1995.